Ureteroscopic Kidney Stone Removal

WHAT YOU SHOULD KNOW:

Ureteroscopy (u-re-ter-OS-kah-pee) is a procedure done to remove kidney stones. Kidney stones are also called renal calculi. Kidney stones are rock-like pieces that can form anywhere in the urinary system. This includes the kidneys, bladder, ureters and urethra (urine tubes). Your kidneys clean waste from the blood and make urine. The stone may be large or small. You may have more than one stone. Ureteroscopy is used when the stone is in the middle or lower part of the ureter. The ureters are the tubes that go from your kidney to your bladder where urine is stored, before it is passed out of your body. Ask caregivers for more information about kidney stones and ways to treat them.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

There are risks with kidney stone removal. You may bleed more than usual or get an infection. You could have trouble breathing or get blood clots. You may need surgery or another procedure if the stone was not broken small enough to pass in your urine. Kidney stones can cause a kidney infection and can stop urine from moving out of your kidney. If a kidney stone causes these problems and you do not get it fixed, your kidneys could stop working. This could cause you to die. Your ureter could be torn or damaged during this procedure. Your ureter may grow scar tissue after the procedure and block the flow of urine.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• KUB x-ray: You may need a KUB x-ray before your procedure. An x-ray machine is used to take pictures of your kidneys, ureters, and bladder. Your caregivers look at these pictures to see where the kidney stone is located before your procedure.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Pre-Op care: You may be given medicine in your IV to make you feel sleepy and more relaxed. You will be taken on a cart to the room where your procedure will be done. Your caregiver will help you get comfortable on the bed. If you get cold, ask for more blankets.
  
  
• Anesthesia: Anesthesia is medicine to make you comfortable during surgery. Caregivers work with you to decide which anesthesia is best and whether you will be awake or completely asleep. Do not make important decisions for 24 hours after having anesthesia. Also, do not drive or use heavy equipment. An adult may need to drive you home and stay with you after you have had anesthesia.
  
  
  • General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
    
    
  • Local or monitored anesthesia: This is a shot of numbing medicine put into the skin where you will have surgery. You may still feel pressure or pushing during surgery but you should not have pain. With local anesthesia, you will be fully awake during the procedure. With monitored anesthesia care, you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the procedure.
    
    
  • Spinal or epidural anesthesia: This is medicine put into your back to numb you below the waist. With spinal anesthesia, the medicine is given through a shot. Feeling returns in about two hours. Epidural anesthesia is put into your back through a tiny tube. The tube may be left in place to give you more medicine later if needed. After epidural anesthesia, feeling returns to your legs when the medicine wears off.

During the procedure:

• You will lie on your back with a sheet covering you during the procedure. Caregivers help you bend your knees and put your feet and legs into stirrups or leg holders. Your groin and urethra (tube that drains urine from the bladder) are cleaned with soap. The soap may make your skin yellow, but will be cleaned off later.
  
  
• A ureteroscope is put through your urethra and bladder into your ureter. The ureteroscope is a long thin tube with a light and magnifying glass on the end. Your doctor will put instruments like tiny forceps through the scope to grab small stones. Larger ones are shattered (broken into tiny sand-like pieces) using a machine such as a drill, ultrasound, or laser. These tiny pieces of stone will be passed in your urine in the next few days.

After the procedure: You will be taken to the recovery room. You will stay there until you wake up. You will then be taken back to your room or will be allowed to go home. Do not get out of bed until your caregiver says it is OK.

• Activity: Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy, sit or lie down right away. Then call your caregiver.
  
  
• Bowel movements: Exercise such as walking can help you have regular bowel movements. Including foods such as fruit, bran, and prune juice, and drinking enough water can also help. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular.
  
  
• Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Drinking liquids: Follow your caregiver's advice about how much liquid you should drink. For most people, good liquids to drink are water, juices, and milk. Limit the amount of caffeine you drink. Caffeine may be found in coffee, tea, soda, and sports foods and drinks. It is very important to drink fluids after kidney stone removal. This helps clean out any remaining small pieces of stone. Drink liquids in the evening to be sure that you will make urine through the night.
  
  
• Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Caregivers often call this "I&O".
  
  
  • Ask your caregiver how much liquid you should be drinking. Write down how much you are drinking, and tell your caregiver.
    
    
  • Caregivers may need to strain your urine to check for stones. Do not flush your urine down the toilet unless caregivers say it is OK.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
    
    
  • Stool softeners: You may be given stool softeners to soften your bowel movements, making them easier to pass.
  
  
• Ureteral stent: This is a small bendable tube that is placed inside your ureter. A stent may help the broken pieces of stone pass and help the lining of the ureter heal.
  
  
• Pressure stockings: These tight elastic stockings help to keep blood from staying in the legs and causing clots. The stockings are also called Ted Hose® or Jobst Stockings®.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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